Should You Remove External Hemorrhoids First? A Guide to Treatment Decisions

Should I address an external mole?

I recently developed a rash near my anus, which was later diagnosed as hemorrhoids (mixed type).
However, the symptoms are mild, and the doctor mentioned that medication treatment is possible.
I've been troubled by the external tags for a long time (previously unaware they were hemorrhoids because I felt no discomfort; I realize now how uninformed I was).
After discussing with my doctor, I would like to first remove the external tags and treat the internal hemorrhoids with medication.
Why do I want to remove the external tags first? Because I suspect they may be causing an infection in my intimate area, so I want to address that first.
Is this decision correct? Should I treat both the internal and external hemorrhoids together? However, I am afraid of hospitalization and pain (and I can't take too many days off work).
The doctor also mentioned that surgery is not necessary at this stage.
Still, I keep thinking about getting rid of the external tags...
Is this decision appropriate? If I leave the internal hemorrhoids untreated, even if I remove the external tags now, will the external tags recur in the future? I've started to worry about post-operative issues these days...
Thank you.

c, 40~49 year old female. Ask Date: 2017/10/31

Dr. Ke Fangxu reply Surgery

If surgery is considered, it is generally recommended to remove both internal and external hemorrhoids together; only clinic physicians might suggest handling them separately.
Additionally, gynecological infections are mostly unrelated to hemorrhoids and should not be considered together.
If external hemorrhoids are not painful or bleeding, surgery offers no significant benefits beyond cosmetic improvement.
Typically, surgery requires a three-day hospital stay, and postoperative pain may last about a week, so it is advisable to prepare mentally before undergoing the procedure.

Reply Date: 2017/10/31

More Info

When considering the treatment of hemorrhoids, particularly external hemorrhoids, it's essential to understand the nature of the condition and the implications of surgical intervention. Hemorrhoids, which can be classified as internal or external, are swollen veins in the rectal area. External hemorrhoids are located under the skin around the anus and can cause discomfort, itching, and sometimes bleeding. Internal hemorrhoids, on the other hand, are located inside the rectum and may not be felt unless they protrude outside.

In your case, you mentioned experiencing mild symptoms associated with hemorrhoids and a desire to remove the external hemorrhoids first while treating the internal ones with medication. This approach can be reasonable, especially if the external hemorrhoids are causing significant discomfort or if you suspect they may be contributing to infections or other complications.

Reasons for Prioritizing External Hemorrhoid Removal
1. Symptomatic Relief: If the external hemorrhoids are causing discomfort, pain, or irritation, removing them can provide immediate relief. This is particularly important if they are affecting your quality of life.

2. Infection Concerns: You mentioned a suspicion that the external hemorrhoids might be contributing to infections in the area. If there is a risk of infection, addressing the external hemorrhoids could help reduce that risk.

3. Simplicity of Procedure: Surgical removal of external hemorrhoids (hemorrhoidectomy) is generally a straightforward procedure that can often be performed on an outpatient basis. This means you may not need to stay in the hospital for an extended period.

4. Focus on One Issue at a Time: By addressing the external hemorrhoids first, you can monitor the situation with the internal hemorrhoids and decide on further treatment based on how your symptoms evolve.

Considerations for Treatment
- Consultation with Your Doctor: It’s crucial to have a thorough discussion with your healthcare provider about your symptoms, the risks and benefits of surgery, and the potential for recurrence of external hemorrhoids. Your doctor can provide personalized advice based on your medical history and current condition.

- Potential for Recurrence: While removing external hemorrhoids can provide relief, there is a possibility that they may recur, especially if the underlying causes (such as straining during bowel movements, constipation, or prolonged sitting) are not addressed. It may be beneficial to discuss lifestyle changes or dietary adjustments that can help prevent future occurrences.

- Managing Internal Hemorrhoids: Continuing with medical treatment for internal hemorrhoids is also important. This may include dietary changes (increasing fiber intake), topical treatments, or other medications as prescribed by your doctor.

- Postoperative Care: After the removal of external hemorrhoids, it’s essential to follow your doctor's postoperative care instructions to minimize pain and reduce the risk of complications, such as infection or bleeding.

Conclusion
Your decision to prioritize the removal of external hemorrhoids while treating internal ones with medication seems reasonable, especially given your concerns about discomfort and potential infection. However, it is vital to maintain open communication with your healthcare provider throughout this process. They can help you weigh the benefits and risks of each treatment option and guide you on the best course of action tailored to your specific situation. Remember that addressing lifestyle factors and following up on the treatment of internal hemorrhoids will be crucial in preventing future issues.

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